application to construct or install an apparatus for the treatment … · address: 7 orchard...

Telephone: (08) 9394 5000 Facsimile: (08) 9394 5184

Website: www.armadale.wa.gov.au Email: [email protected]

Address: 7 Orchard Avenue, Armadale, Western Australia 6112

Application to Construct or Install an Apparatus for the Treatment of Sewage

Application Details (please tick as appropriate)

Application is for a single effluent disposal system on a single lot for a single residence (include 2 copies of plans*)

Application is for a non-residential development producing no more than 540L per day (include 2 copies of plans*)

Application is for an additional (second) system or one producing more than 540L per day (include 3 copies of plans*)

*Plans are to be to scales of 1:100 or 1:200

Location of Installation

Lot Number: House Number:

Street and Suburb:

Owner and Applicant Details

Owner’s Name:

Postal Address: Postcode:

Daytime Phone:

Applicant’s Name:

Applicant’s Address: Postcode:

Email Address:

Daytime Phone: Mobile Phone:

Note: the approved application will be returned to the applicant only.

Premises Details (please tick as appropriate)

New Development Existing Development

Residential Commercial Industrial

Single Dwelling Multiple Dwellings Ancillary Accommodation

Other (please specify)

Number of bedrooms (for residential dwelling only – includes enclosed studies):

Expected daily waste water volume (non-residential premises only): Litres/Day

Is there a spa with a capacity exceeding 350 Litres? Yes No

Is there an existing effluent disposal system on site? Yes No




Premises Details (please tick as appropriate)

Type of Apparatus

Septic tank(s) Diameter sizes:

Greywater system Manufacturer and Model:

Aerobic Treatment Unit Manufacturer and Model:

Pump Tank Diameter sizes:

Other Please specify: Type of Disposal System

Concrete leach drains Manufacturer and Length:

Plastic leach drains Manufacturer and Length:

Other leach drain type Manufacturer and Length:

Irrigation area Area size:

Disposal technique: Surface Spray

Subsoil Dripper

Substrata Dripper

Other Please specify: Site Conditions (please tick as appropriate)

Soil Type Sand Gravel Loam Clay

Other Please specify:

Depth from natural ground level to highest known water table:

Distance from natural water bodies if less 100m

Will the leach drains be within 30m of a bore, dam or water course used for drinking water? Yes No

Will the system be in an area subject to flooding or inundation in a 1 in 10 year event? Yes No Declaration and Signature of Application I hereby apply as the owner, or the person authorised to act on behalf of the owner, for approval to construct or install the apparatus as referred to above. I confirm that, to the best of my knowledge, the information provided in this application is a true and an accurate reflection of circumstances.

Applicant’s Signature: Date:

Please print full name:




Additional Information for Applicants

Required Drawings Each application must be accompanied by the required number of drawings as indicated in the Application Details section. Drawings are to include the following:

Scale of drawing - either 1:100 or 1:200

Position of effluent disposal system, drains and pipes

Distance of the apparatus to buildings, boundaries, bores, streams and waterbodies

Distance of appartus from all trafficable areas

Site plan to show contour lines indicating the gradient of the land

Aerobic Treatment Units If the application is for an Aerobic Treatment Unit, a copy of the maintenance agreement between the owner and the authorised service company must also be included.

Submission of Application All applications are to be submitted to the City of Armadale.

However the City can only approve applications for a single effluent disposal system on a single lot for a residence or other development producing no more than 540L per day. For all other applications approval will be required from the Department of Health.

Where Department of Health approval is required, the City will produce a Local Government Report and forward on the application. Please note that in these circumstances an additional copy of plans is required and there is a separate Department of Health application fee.

Lodgement can be made by any of the following;

In Person: City of Armadale Administration Building, 7 Orchard Avenue, Armadale By Mail: Locked Bag 2 Armadale, Western Australia 6992 By Email: [email protected]

Work not to Commence until Approval Granted

Please note that it is an offence under Section 107(2) of the Health Act 1911 to start work on the construction or installation of an on site effluent disposal system without approval.

Permit to Use

When you have obtained approval, you may proceed with the construction or installation of the apparatus. However before sealing the septic tank(s) or covering the opening to the drains, they must be inspected by the City and a Permit to Use issued. To arrange an inspection by an Environmental Health Officer from the City please telephone 9394 5495.

Please note that it is an offence under Section 107(4) of the Health Act 1911 to use an apparatus before it has been inspected and a permit to use the apparatus issued.

The ‘Permit to Use Appartus’ is issued to the owner of the property.




Fees

The following fees apply:

Payable to the City of Armadale either via cash, cheque, money order or credit card (do not send Credit Card details via email).

• Application requiring City of Armadale approval only $236.00

• Application requiring a Local Government Report to theDepartment of Health for

approval $193.00

• Re-Inspection Fee (due to unsatisfactory or incomplete work) $254.00

* Applications requiring Department of Health approval are required to pay an additional fee of $56.00for which the Department will send out a separate invoice following referral of the application by the City.

Payment Options

Pay in Person: Pay via cash, EFTPOS, cheque, money order or credit card at the Cashier at City of Armadale Administration Centre, 7 Orchard Avenue, Armadale between 8.15am and 4.45pm Monday to Friday.

Pay by Mail: Pay via credit card, cheque or money order payable to the City of Armadale to Locked Bag 2, Armadale WA 6992.

Pay by Credit Card: The City will only be able to accept completed credit card forms by post, in person or by telephone. Emailed or faxed credit card details will result in the application being returned unprocessed. Contact Health Services Administration 9394 5418 regarding payment.

Credit Card Payment Form - By Post Only

Name as shown on Card:

Is this a Business Credit Card? � Yes* � No

* If ‘Yes’, please provide business name to receipt payment to:

Postal address for receipt, if different to the applicant’s address:

Type of Card: � Master Card � Visa Expiry Date /

Amount $ Signature:

Card No. �� Further Information

Should you have any queries regarding any of the above, please do not hesitate to contact the City of Armadale’s Health Services on 9394 5495 or visit www.armadale.wa.gov.au

application to construct or install an apparatus for the treatment … · address: 7 orchard...

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